Combined Method of Bladder Neck Closure and Concomitant Augmentation Cystoplasty in the Setting of Refractory Urinary Incontinence

Objective To describe the technique of concomitant bladder neck closure and augmentation cystoplasty in a 22-year-old woman with a history of bladder exstrophy and refractory urinary incontinence. This patient had prior augmentation cystoplasty and circumferential fascial urethral sling placement with continued incontinence. During closure of the bladder neck, the bladder neck was incorporated into the augmentation cystoplasty to help prevent failure of bladder neck closure. Material and Methods The patient had previously undergone augmentation cystoplasy, circumferential fascial urethral sling placement, and antegrade collagen injection of the bladder neck. Despite these interventions, she continued to have refractory urinary incontinence. Her bladder neck was closed by incorporating the bladder neck into the cystotomy and using the bladder neck as an edge of anastomosis during augmentation cystoplasty. Results The patient tolerated the procedure well. She catheterizes easily through her appendicovesicostomy and has remained continent. She has no leakage from her closed bladder neck 30 months after closure. Conclusion Incorporating the bladder neck into the cystotomy during a planned augmentation cystoplasty and bladder neck closure should be considered as an alternative to separate bladder neck closure, which can fail and can result in continued urinary incontinence.